I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?) I am currently exploring controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care spending. My books include Pricing Life (MIT Press 2000) and Free Market Madness (Harvard Business Press, 2009). My newest book, Critical Decisions (HarperCollins), explores the challenges of shared decision making between doctors and patients.

Why Many Physicians Are Reluctant To See Medicaid Patients

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% of what Medicare pays, nationally, for outpatient physician services. The payment rate varies from state to state, of course. But if 61% is average, you can imagine how terrible the situation is in some locations. Physicians interviewed in the study explained that they felt it was their duty to see some amount of Medicaid patients in their practice. They recognized the moral need to provide care for this population. But they did not want to commit career suicide – they did not want good deeds to bankrupt their clinical practices.

But reimbursement rates were not the only story. Many physicians talk about unacceptable waiting times to receive reimbursement from their state Medicaid programs. To make matters worse, these low reimbursements came on top of increasingly complex paperwork that their office staff are forced to fill out. Less money and a month late too. Not a recipe for happiness.

But I’m not done yet. Because in addition to getting less money after a longer wait, most physicians were also reluctant to take on many Medicaid patients in their practices because these patients often required much more time and attention than the average patient. In their experience, many physicians felt that the social and behavioral needs of Medicaid patients required a disproportionate share of their time, and of their support staff.

The following picture summarizes the concerns that came up in this study:

Click image to enlarge

The quick version of this figure is: the red bars and green bars show how many doctors have more problems with Medicaid patients than commercial, with those really short blue bars illustrating the rare physicians who think commercial patients raise more problems than Medicaid enrollees. The situation doesn’t look very good for Medicaid right now.

Is this simply more proof that the government can’t be trusted with people’s healthcare coverage? Of course not. If this figure compared Medicare to commercial insurance, I expect it would be a pretty even battle. Instead, this figure illustrates just how little public desire there is to take adequate care of the health care needs of poor people. We can’t simultaneously starve a government program of adequate resources and then complain that the program can’t pull its weight. Some states do a much better job with their Medicaid programs than others. We ought to take advantage of the “laboratory of states” and adopt these better practices. We owe that to those citizens among us who are less fortunate than we are.

Meanwhile, this study acts as yet another reminder that we cannot assume that offering people Medicaid coverage will necessarily provide them with adequate access to health care services.

Post Your Comment

Post Your Reply

Forbes writers have the ability to call out member comments they find particularly interesting. Called-out comments are highlighted across the Forbes network. You'll be notified if your comment is called out.